Establishment and validation of standardized animal models of spinal cord injury by normal external force-caused fracture dislocation

The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices, designed in-house, to construct standardized ventral and dorsal spinal cord injury animal models of 6 g and 17 g falling from a height of 2, 4, and 10 cm, and 15, 30 or 50 g transversal compression on the spinal cord. The results showed that gradual increases in the degree of histopathological injury led to decreased Tarlov and Basso, Beattie and Bresnahan scores for the behavioral test, and increased Ashworth scores for the hind limb. Furthermore, there was a gradual decline in the slope test in the rats with dorsal spinal cord injury that correlated to increases in the falling substance weight or falling height. Similar alterations were observed in the ventral spinal cord injured rats, proportional to the increase in compression weight. Our experimental findings indicate that the standardized experimental rat models of dorsal and ventral spinal cord injury are stable, reliable and reproducible.

Treatment of Fracture Dislocation of the Femoral Head in a Resource Limited Country (Burundi)

Introduction: Fractures of the femoral head are rare injuries which generally follow a traumatic dislocation of the hip or in a poly-trauma scenario. A fracture dislocation of the femoral head is an orthopedic emergency. The most frequent complications after a fracture of the femoral head are osteonecrosis, post traumatic arthritis and heterotopic ossification. Objective: To focus on the therapeutic aspect of fracture-dislocations of femoral head and their short- and long-term prognoses. Materials and Methods: This is a prospective study conducted at Kamenge teaching hospital and Rohero Christian medical and surgical clinic from January 2013 to August 2020. All patients diagnosed with fracture-dislocations of the femoral head were included in this study. Results: Five patients were admitted for fracture dislocation of the femoral head. The mean age was 40.4 years and varied between 25 and 55 years. The dashboard injury was the most common mechanism and was found in four patients (80%). A standard x-ray was performed for the five patients as well as CT scans in two cases. All patients had posterior iliac dislocations with fractures of the femoral head classified as Pipkin I in three patients and Pipkin III in two patients. Closed reduction under general anesthesia within six hours was possible in one among the five patients and within 12 hours in two patients. These three cases were managed with open reduction and internal fixation (ORIF) via anterior approach with screw fixation of the femoral head fragment. In the two remaining patients reduction was not possible and for one of them there was a femoral neck fracture following closed manipulation, making the fracture Pipkin III. The two patients with Pipkin III injuries were managed with total hip replacement. With an average follow up of five years, standard x-rays of the three patients who had ORIF showed fracture union without avascular necrosis, posttraumatic arthritis or heterotopic ossification. The functional results for the five patients with an average follow up of four years were very good (3/5) and good (2/5). Conclusion: The diagnosis of fracture dislocations of the femoral head was based on clinical, radiographic and computed tomography criteria. Early reduction and internal fixation can restore the natural anatomy of the hip joint, especially in young adults with a good long-term prognosis. Sometimes total hip replacement is necessary for management of fracture dislocations of the femoral head.

Combined fracture dislocation of the navicular bone along with cuboid, cuneiform and longitudinal split fracture of the lateral malleolus： a rare combination of fractures

Fracture dislocation of the navicular bone~ fracture of the cuboid, cuneiform, and longitudinal split fracture of the lateral malleolus is a rare combination of fractures. This is a high velocity injury fracture and can be caused by forcible plantar flexion and inversion of the foot at the time of impact onto the ground. Here we reported such a case in a 35-year-old male patient who was treated by open reduction and fixation with a partially threaded screw and two K-wires for the navicular bone,and two interfragmentary screws with a one third tubular plate for the lateral malleolus. K-wires were removed 6 weeks after surgery followed by partial weight bearing. After 6 months, the patient can walk normally with minimal pain and swelling of the foot.

Bilateral central acetabular fracture dislocation in a young patient due to seizure activity： a case report and review of the literature

Various musculoskeletal injuries are well known complications of epilepsy either because of direct trauma or because of unbalanced forceful muscle contraction. We report a case of non-traumatic bilateral central acetabular fracture dislocation due to seizure activity induced by neurocysticercosis of the brain, which was managed conservatively and obtained reasonable good outcome. This case highlights the importance of proper evaluation in young non-osteoporotic patients who have experienced an epileptic attack without any previous history. It is also imperative to mention that these patients should be thoroughly examined neurologically to find out the exact etiology and should be treated accordingly to prevent future seizure activity.

Simultaneous bilateral shoulder and bilateral central acetabular fracture dislocation： What to do？

Musculoskeletal injuries following seizures have a high morbidity and mortality. These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations. We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure. Present study high- lights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures. Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery. Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.

OPEN REDUCTION AND CANNULATED SCREW INTERNAL FIXATION OF TALUS FRACTURE-DISLOCATION THROUGH MEDIAL-ANTERIOR APPROACH

Objective To evaluate the role of open reduction through anterior-medial malleolar approachwith cannulated screw internal fixation in the treatment of displaced talus fractures. Methods 16 cases of Hawkin type Ⅱ - Ⅲ displaced talus fractures were treated by open reduction through single anterior medial malleolar approach with cannulated screw internal fixation. Results All the 16 cases of displaced talus fractures achieved bony heal in which 5 cases suffered talus aseptic necrosis. The whole excellence-good ratio reached 62. 5%. Conclusion Open reduction through anterior-medial malleolar approach with cannulated screw internal fixation is a less trauma, easy manipulation, effective method of treatment for displaced talus fractures.

THE OPERATIVE TREATMENT OF SPINAL FRACTURE-DISLOCATION WITHOUT NEUROLOGIC DEFICITS

To evaluate the results of operative treatment of spinal fracture dislocation without neurologic deficits. Methods.Eighteen patients with spinal fracture dislocation were neurologically intact at the time of injury, and all were treated operatively. The fracture sites were:8 cases in cervical spine, 3 cases in thoracic spine, and 7 cases in lumbar spine. Eight patients with cervical injuries had variant degrees of forward slide and kyphotic deformity. Of the 10 thoracic and lumbar fractures, one had lateral dislocation, 4 cases with kyphotic deformities, 5 cases with spinal canal compromise averaged 50% (ranging from 40% to 70%). Results.The average period of follow up was 4.4 years with a range of 11 months to 13 years. All the patients returned to full time work. No patient developed neurologic deterioration. Kyphotic deformity was corrected in the 4 cases, and no progressive kyphosis was noted. There was no operation related complication. The averaged post operative hospitalization time was 13 days. Conclusions. Despite the rare incidence of spinal fracture dislocation without neurologic deficits, we suggested that kind of fracture be considered unstable fracture because of its potential risk of delayed neurologic deterioration and kyphotic deformity, and be treated operatively to restore the sagittal alignment and the stability of the spine.

Characterization of Hydraulic Fracture with Inflated Dislocation Moving Within a Semi-infinite Medium

Hydraulic fracturing is accompanied by a change in pore fluid pressure. As a result,this may be conveniently represented as inflated dislocation moving within a semi-infinite medium. Theory is developed to describe the pore pressures that build up around an inflated volumetric dislocation migrating within a saturated porous-elastic semi-infinite medium as analog to hydraulic fracturing emplacement. The solution is capable of evaluating the system behavior of both constant fluid pressure and zero flux surface conditions through application of a superposition. Characterization of horizontal moving dislocation processes is conducted as an application of these techniques. Where the mechanical and hydraulic parameters are defined,a priori,type curve matching of responses may be used to evaluate emplacement location uniquely. Pore pressure response elicited at a dilation,subject to pressure control is of interest in representing hydraulic fracturing where leak-off is an important component. The effect of hydraulic fracturing on fracture fluid pressure is evaluated in a poroelastic hydraulic fracture model utilizing dislocation theory. A minimum set of dimensionless parameters are defined that describe the system. Pore fluid pressures recorded during hydraulic fracturing of a well in the San Joaquin Valley of Central California is examined using the proposed model. The estimated geometry of the hydraulic fracture is matched with reasonable fidelity with the measured data.

Use of oral ketamine for analgesia during reduction/manipulation of fracture/dislocation in the Emergency Room: An initial experience in a low-resource setting

Background: The use of ketamine for relief of procedure-related pain is limited in our environment. Ketamine, a phencyclidine derivative commonly used for induction and maintenance of anaesthesia, is administered routinely via the intravenous and intramuscular routes. One of the concerns while using ketamine for analgesia via these two routes is that the drug may produce anaesthesia, rather than analgesia alone. Aims and Objectives: We sought to find out if ketamine given via the oral route could be used to provide analgesia during minor orthopaedic procedures in the emergency room. We also wanted to find out if there were side-effects peculiar to the oral route. Methods: A prospective observational pilot study in consecutive patientswith fractures/dislocation in our Emergency Room was recruited into the study. All patients gave informed consent. Reduction of fractures was done 15 minutes following the administration of ketamine 5 mg/kg orally. The patients were observed during and after the procedure and the findings entered into a proforma. The data obtained were analyzed using simple statistical methods and the results presented in a table. The findings are discussed. Results: There were 9 males and 2 females with an age range of 4 yrs to 48 yrs. Pain levels were assessed using verbal rating scales. Seven patients (64%) had severe pain before administration of ketamine while 2 patients (18%) each had mild and moderate pain respectively. Four patients had Colle’s fracture only and 1 patient had a Colle’s fracture with a supracondylar femoral fracture. Two patients had tibial fractures, one patient had a complete knee dislocation, while 2 others had ulnar/radial fractures. One other patient had humeral and tibial fractures. For up to 15 minutes after the procedures all but one patient were pain-free. Five (5) patients (45.5%) were noticed to have drowsiness, 3 patients (27%) were sedated while 2 patients (18%) had no side-effects at all. Five (5) patients (45.5%) reported excellent analgesia while 6 patients (64%) said the intra and post procedure analgesia was very good. Conclusions: Oral ketamine may be useful in providing analgesia for minor procedures in the emergency room. Ketamine when sweetened with a soda drink appears to be palatable with a rapid onset of action and few side effects. Thus ketamine given orally may be a cheaper and more accessible option for effective pain-relief in the emergency room. There is a need to conduct more studies on a larger number of patients.

Clinical application of anterior cervical decompression and fusion under METRx system

Objective: To explore the feasibility and effect of anterior cervical decompression and fusion under METRx system. Methods: Between Nov. 2001 and Nov. 2003, totally 23 consecutive patients were performed anterior cervical decompression and fusion under METRx system. The clinical outcome was evaluated by Odom standard. Results: Decompression and fusion along with internal fixation was obtained in all the 23 patients with minimal tissue damage and operation-caused scar. There were no wound infection, neurological injuries, throat discomfort and other complications. The total rate of excellent and good outcome in patients with degenerative cervical diseases was 94%. Conclusion: Cervical decompression and fusion can be performed under METRx system with its own advantages, such as minimal tissue damage and operation-caused scar, less throat discomfort.

Manubriosternal dislocation with spinal fracture： A rare cause for delayed haemothorax

Type 2 manubriosternal dislocations with concomitant spinal fracture are rare and may be associated with thoracic visceral injuries. The complication of delayed haemothorax has not been reported yet. We report a case of a young male who suffered manubriosternal dislocation with chance type thoracic spine fracture due to fall of a tree branch over his back. The haemothorax presented late on day three. The possible injury mechanism is discussed along with review of literature. We conclude that a lateral chest radiograph is indicated in spinal fracture patients complaining of midsternal pain. Computerized axial tomography scan of chest with contrast is indicated to rule out visceral injuries and a chest radiograph should be repeated before the patient is discharged to look for delayed haemothorax.

CRACK TIP STRUCTURE AND DUCTILE-BRITTLE TRANSITION IN BULK SINGLE CRYSTALS

Based on the crack tip structure a new model of ductile -brittle transition was proposed. Using this new model we calculated the dependence of the transition temperature-strain rate over a wide range of strain rate. Finally the significance of this new model is discussed in detail.

Mechanisms of mid-thoracic spine fracture/dislocation due to falls during horse racing:A report of two cases

We reported two cases of jockeys who sustained fracture/dislocation of the mid-thoracic spine due to traumatic falls during horse racing.We examined the injury mechanism based upon the patients’diagnostic images and video footage of races,in which the accidents occurred.Admission imaging of patient 1(a 42 years old male)revealed T5 burst fracture with bony retropulsion of 7 mm causing complete paralysis below T5/6.There existed 22°focal kyphosis at T5/6,anterolisthesis of T5 relative to T6,T5/6 disc herniation,cord edema and epidural hemorrhage from T4 through T6,and cord injury from C3 through C6.Admission imaging of patient 2(a 23 years old male)revealed T4/5 fracture/dislocation causing incomplete paralysis below spinal level.There existed compression fractures at T5,T6,and T7;4 mm anterior subluxation of T4 on T5;diffuse cord swelling from T3 through T5;comminuted fracture of the C1 right lateral mass;right frontal traumatic subarachnoid hemorrhage;and extensive diffuse axonal injury.The injuries were caused by high energy flexion-compression of the mid-thoracic spine with a flexed posture upon impact.Our results suggest that substantially greater cord compression occurred transiently during trauma as compared to that documented from admission imaging.Video footage of the accidents indicated that the spine buckled and failed due to abrupt pocketing and deceleration of the head,neck and shoulders upon impact with the ground combined with continued forward and downward momentum of the torso and lower extremities.While a similar mechanism is well known to cause fracture/dislocation of the cervical spine,it is less common and less understood for mid-thoracic spine injuries.Our study provides insight into the etiology of fracture/dislocation patterns of the mid-thoracic spine due to falls during horse racing.

An unusual Monteggia equivalent type 1 lesion： Diaphyseal ulna and radius fractures with a posterior elbow dislocation in a child

In this report, we describe an extremely unusual Monteggia equivalent type 1 lesion in a 10-year-old boy following a fall from a height of I m. On the plain radiographs, our patient had a particular Monteggia equivalent type 1 injury associating a posterior elbow dislocation with diaphyseal radius and ulna fractures. The patient was treated by closed reduction technique. At six months of follow-up, the frac- tures were consolidated and the elbow was stable. To our knowledge, only 8 adult cases and one pae- diatric observation with similar lesions had been reported through medical literature. Therefore, the aim of our case report is to remind this rare entity and also to provide a comprehensive review of the literature related to this uncommon lesion.

A six months old neglected anterior shoulder dislocation managed by closed reduction and Latarjet procedure

A neglected shoulder dislocation is a rarer entity and only few cases are reported in the literature. An anterior dislocation of the shoulder is rarely missed as patients present with limb in abduction and external rotation, an attitude very familiar to orthopaedic surgeon. Occasionally such cases are missed when they present with fracture of proximal humerus or when they receive treatment from unqualified practitioners who commonly practise in rural areas. Owing to very few reports there is paucity of literature and no standard treatment protocol exists for neglected anterior dislocation of the shoulder. though most such chronic cases are managed by open reduction. This case report describes a six months old neglected anterior dislocation with a significant Hill Sachs lesion, which was managed by closed reduction and Latarjet procedure.

Inferior glenohumeral joint dislocation with greater tuberosity avulsion

Inferior glenohumeral dislocation is the least common type of glenohumeral dislocations. It may be associated with fractures of the adjacent bones and neurovascular compromise. It should be treated immediately by close reduction. The associated neuropraxia usually recovers with time. Traction-counter traction method is commonly used for reduction followed by immobilization of the shoulder for three weeks. Here, we report a case of inferior glenohumeral joint dislocation with greater tuberosity fracture with transient neurovascular compromise and present a brief review of the literature.

Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries:A case report and literature review

Spondyloptosis in the clinic is rarely reported.We herein present a 47-year-old female,who suffered from a crush injury directly by a heavy cylindrical object from the lateral side.She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas.Staged surgical procedures were conducted and a three-year follow-up was obtained.Eventually,normal spinal alignment was restored,and neurological deficits were gradually improved.At three years follow-up,the motor strength scores and function of the sphincters were incompletely improved.Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed.First,thoracolumbar and lumbosacral junction were mostly predilection sites.Second,numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A.Third,lumbar spondyloptosis was commonly coupling withcauda equina injury.Finally,the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity.Based on this case report and literatures review,we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas.Furthermore,we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.

Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma

Purpose:The technology of 3D printing(3DP)exists for quite some time,but it is still not utilized to its full potential in the field of orthopaedics and traumatology,such as underestimating its worth in virtual preoperative planning(VPP)and designing various models,templates,and jigs.It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications.Methods:An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation.Virtual preoperative planning and 3DP were used in the management of these fractures.Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data.Results:In all the 91 cases,where VPP and 3DP were used,the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively.Surgical time was reduced,with a better outcome.Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation.The average score of the questionnaire was 4.5,out of a maximum of 6,suggesting a positive role of 3DP in orthopaedics.Conclusion:3DP is useful in complex trauma management by accurate reduction and placement of implants,reduction of surgical time and with a better outcome.Although there is an initial learning curve to understand and execute the VPP and 3DP,these become easier with practice and experience.